Impact of contact force technology on reducing the recurrence and major complications of atrial fibrillation ablation: A systematic review and meta-analysis

Abstract

Contact force (CF) monitoring can be useful in accomplishing circumferential pulmonary vein (PV) isolation for atrial fibrillation (AF). This meta-analysis aimed to assess the efficacy and safety of a CF-sensing catheter in treating AF. Randomized controlled trials or non-randomized observational studies comparing AF ablation using CF-sensing or standard non-CF (NCF)-sensing catheters were identified from PubMed, EMBASE, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure (January 1, 1998–2016). A total of 19 studies were included. The primary efficacy endpoint was AF recurrence within 12 months, which significantly improved using CF-sensing catheters compared with using NCF-sensing catheters [31.1% vs. 40.5%; risk ratio (RR)=0.82; 95% confidence interval (CI), 0.73–0.93; p<0.05]. Further, the acute PV reconnection (10.1% vs. 24.2%; RR=0.45; 95% CI, 0.32–0.63; p<0.05) and incidence of major complications (1.8% vs. 3.1%; OR=0.59; 95% CI, 0.37–0.95; p<0.05) significantly improved using CF-sensing catheters compared with using NCF-sensing catheters. Procedure parameters such as procedure duration [mean difference (MD)=-28.35; 95% CI, -39.54 to -17.16; p<0.05], ablation time (MD=-3.8; 95% CI, -6.6 to -1.0; p<0.05), fluoroscopy duration (MD=-8.18; 95% CI, -14.11 to -2.24; p<0.05), and radiation dose (standard MD=-0.75; 95% CI, -1.32 to -0.18; p<0.05] significantly reduced using CF-sensing catheters. CF-sensing catheter ablation of AF can reduce the incidence of major complications and generate better outcomes compared with NCF-sensing catheters during the 12-month follow-up period.

Low-fluoroscopy atrial fibrillation ablation with contact force and ultrasound technologies: a learning curve

“…The single complication was well within reported rates for AF ablation,7 and overall freedom from AF at 1 year after ablation was also similar to published rates 1,7. In addition to the expected reductions in fluoroscopy over the implementation period for this new low-fluoroscopy workflow, the large increase in effectiveness from the first 1/3 procedures to the later 2/3 procedures was a striking unforeseen benefit.…”

Long-term safety and effectiveness of paroxysmal atrial fibrillation ablation using a porous tip contact force-sensing catheter from the SMART SF trial

“…Compared with the original THERMOCOOL AF IDE study, conducted almost a decade ago, the current success rates in the SMART AF and SMART SF studies are substantially higher (74–75% vs. 66%) [ 7 ]. This finding is further supported by a previous meta-analysis across CF vs non-CF studies showing a decrease in 12-month AF recurrence with the use of CF technology [ 14 – 16 ]. The upward trend in long-term success over time and over CF vs. non-CF ablation studies is encouraging and consistent with the expectation of improved outcomes due to advancement in technologies and catheter ablation experience.…”

Evolution of Force Sensing Technologies

“…Despite the absence of prospective randomised clinical studies with longer follow up, RF ablation guided by real-time CF sensing has become the dominant ablation modality, particularly for catheter ablation of AF. [37][38][39] If however, the better acute outcomes with reduction in acute electrical PV re-connection shown in medium term studies, 40 is borne out in studies with appropriate longer-term follow-up, then CF sensing technology has the potential to become the recommended standard of care for all patients undergoing AF catheter ablation. n…”